Provider Demographics
NPI:1669822847
Name:PEARSON, PATRESHA PAMELLA (MSN BSN RN)
Entity Type:Individual
Prefix:PROF
First Name:PATRESHA
Middle Name:PAMELLA
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MSN BSN RN
Other - Prefix:
Other - First Name:PATRESHA
Other - Middle Name:
Other - Last Name:LAVORGNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:200 E KNOX RD LOT 44
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3325
Mailing Address - Country:US
Mailing Address - Phone:760-402-6788
Mailing Address - Fax:
Practice Address - Street 1:200 E KNOX RD LOT 44
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3325
Practice Address - Country:US
Practice Address - Phone:760-402-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ127955163W00000X
AZRN 1279553747A0650X
CA631334374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel